Individual
JACOB W. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
824 S DIAMOND ST, NAMPA, ID 83686-5960
(208) 812-4999
(208) 634-4055
Mailing address
PO BOX 2553, MCCALL, ID 83638-2553
(208) 630-4040
(208) 634-4055
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW30132
ID
Other
Enumeration date
05/03/2012
Last updated
07/12/2023
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